Provider Demographics
NPI:1235134305
Name:MCRAE, GINA A (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:A
Last Name:MCRAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:STE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:21 RIDGE DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35213-3633
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL187332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051525166OtherBLUE CROSS
AL051512462OtherBLUE CROSS
AL051550389Medicaid
AL009938679Medicaid
AL009938677Medicaid
AL051502805Medicare PIN
AL051550389OtherBLUE CROSS
AL051501529OtherBLUE CROSS
G51190Medicare UPIN
AL051501530OtherBLUE CROSS
AL051512464OtherBLUE CROSS
AL051510984OtherBLUE CROSS
AL009938753Medicaid
AL051555272Medicare PIN
AL300118621Medicare PIN
AL009938683Medicaid
AL009938681Medicaid
AL051512932OtherBLUE CROSS
AL051550389Medicare PIN
AL051539883OtherBLUE CROSS
AL009992465Medicaid
AL009938682Medicaid
AL051502805OtherBLUE CROSS
AL009938821Medicaid
AL009938678Medicaid